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HEC Forum (2006) 18 (1): 61-84.

Stark Regulation: A Historical and Current Review of the Self-Referral Laws .

Introduction:

Self-referrals to entities with which a practitioner has a financial relationship may encourage over utilization, and compromise the physicians’ judgment as to whether the referral or service is medically necessary (DHHS, 2004). H.R. 2264, The Omnibus Budget Reconciliation Act of 1993 (OBRA 93) contains provisions in section 13562 that address physician ownership and referral (Stark, 2000). OBRA 93, informally known as “Stark II”, prohibits physician referrals for certain designated healthcare services (DHS) to entities in which the referring physician or an immediate family member has a financial interest (Stark, 2000; Siegal, 2004). The intended effect of this legislation is to prevent abusive referral patterns, and discourage physician ownership of various ancillary services to which Medicare and Medicaid patients are referred for DHS. Physician ownership of healthcare businesses to which they refer patients has been debated in the literature (Hillman, Joseph, and Mabry et al., 1990; Mitchell and Scott, 1992a). These arrangements have attracted attention in the medical community, media, and from healthcare policymakers. Physician ownership and referral has also been the subject of government study and legislation (Hillman, Joseph, and Mabry et al., 1990; Mitchell and Scott, 1992a, 1992b). Evidence of overutilization leading to the current physician ownership laws was first reported in 1989 in an OIG report, that investigated physician owned laboratory ventures (Office of Inspector General, 1989). Following the OIG report the Florida legislator commissioned a study, which reported, increased utilization of physical therapy, diagnostic imaging, and clinical laboratory services (Joint Ventures Among Health Care Providers in Florida, 1991). In addition, the study found gross and net revenues were thirty to forty percent higher in physician owned facilities. DOI: 10.1007/s107

Morey J. Kolber, PT, MSPT, Cert MDT, CSCS, Director of Clinical Services, Physical Therapy Institute, Inc., 4800 Linton Blvd., Suite F116, Delray Beach, Florida 33445; email: mokolber@adelphia.net Stark Regulation:

Full article:  https://olis.leg.state.or.us/liz/2015R1/Downloads/CommitteeMeetingDocument/62436

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